高龄脑梗死患者阿替普酶静脉溶栓治疗的安全性与疗效观察

目的：研究使用阿替普酶静脉溶栓治疗高龄急性脑梗死患者的安全性和疗效。方法：采用回顾性分析方法，连续纳入给予阿替普酶静脉溶栓治疗的急性脑梗死患者，按年龄分成≥80岁组（16例）和〈80岁组（79例），并收集同一时段住院的30名年龄〉80岁未行溶栓治疗的急性脑梗死患者作为对照组，比较三组患者的一般情况，统计分析溶栓治疗患者的并发症，采用改良Rankin量表（ MRS）对三组患者3个月预后进行分析。结果：①年龄〈80岁和年龄≥80岁溶栓治疗组比较，两组溶栓后24h颅内出血（ICH）发生率分别为13.9%和18.7%，症状性颅内出血（SICH）发生率分别为5.1%和6.3%，两组间差异均无统计学意义（P〉0.05）；②年龄〈80岁组和年龄≥80岁组患者3个月预后良好比例差异无统计学意义（P〉0.05），但前者预后极差比例明显低于后者（P〈0.05）；③年龄≥80岁组的3个月预后良好比例明显高于对照组（P〈0.05），而两组预后极差比例的差异无统计学意义（P〉0.05）。结论：高龄脑梗死患者静脉使用阿替普酶溶栓安全有效。

Efficacy and Safety of Intravenous Thrombolytic Therapy with Alteplase in Aged Patients with Cerebral Stroke

Objective： To explore the safety and efficacy of intravenous thrombolysis therapy with tissue plasminogen activator （ tPA） in aged acute ischemic stroke patients. Methods：The patients treated with intravenous tPA were analyzed and divided into≥80-year group （n=16） and 〈80-year group （n=79）, and 30 hospitalized patients with the age above 80 years without thrombolytic therapy were selected as the control group. The prognosis of the three groups was compared. Results：①The incidence of ICH in the two thrombolysis therapy groups was 13. 9% and 18. 7% in 24h, and that of SICH was 5. 1% and 6. 3% with no significant difference （P〉0. 05）. ② No significant difference was found in favorable prognosis between the two therapy groups 90 days after thrombolysis （P=0. 771）, while very bad prognosis rate was higher in the≥80-year group than in the 〈80-year group （P〈0. 05）. ③The≥80 years group had an increased favorable outcome compared with the control group （P〈0. 05）, while the very bad prognosis rate in the two groups showed no significant difference （P〉0. 05）. Conclusion：It is safe and effective for old patients to receive IV-tPA throm-bolysis therapy.